Neuropsychiatric symptoms are a common complication of COVID-19, with symptoms documented both during acute COVID-19 infection (parainfectious) and persisting or developing after the resolution of respiratory symptoms (postinfectious). Patients have presented with a variety of symptoms such as anosmia, thrombotic events, seizures, cognitive and attention deficits, new-onset anxiety, depression, psychosis, and rarely catatonia. Etiology appears to be related to disruption of regular neurotransmission and hypoxic injury secondary to systemic inflammation and cytokine storm. Although rare, catatonia and each of its subtypes have now been reported as complications of COVID-19 and therefore should be considered known to occur in both the parainfectious and postinfectious states. Diagnosis of catatonia in the context of COVID-19 should be considered when work-up for more common medical causes of encephalopathy are negative, there is no identifiable psychiatric etiology for catatonia, and there is a positive response to benzodiazepines.
Introduction: Clozapine is the most effective antipsychotic used for treatment resistant schizophrenia and recurrent suicidal behavior in schizophrenia or schizoaffective disorder. However, it has been underutilized due to its adverse reaction profile. Although clozapine is typically associated with neutropenia leading to increased risk of infection (i.e., pneumonia), there have been a few case reports of non-neutropenic, non-infectious drug-induced lung disease (i.e., pneumonitis). Although pneumonia and pneumonitis may have similar clinical presentation, their etiology, management, and treatment are different. Case presentation: A 53-year-old African American female with schizoaffective disorder was hospitalized for being no longer able to appropriately utilize food, clothing, and shelter. The patient developed a sepsis-like presentation during clozapine titration which resolved after treatment for presumed pneumonia and clozapine discontinuation. When clozapine was resumed due to persistent psychosis, the patient again developed a sepsis-like presentation. Clozapine was again discontinued with no other interventions and the patient's symptoms resolved. Conclusions: Drug-induced pneumonitis is a very rare adverse reaction of clozapine. Recognizing conditions that mimic sepsis may prevent patients from undergoing unnecessary laboratory testing and prevent exposure to unwarranted antibiotics.
Splenic abscesses are a rare infection that usually requires seeding from another primary source; however, direct contact of bacteria can occur with microperforation secondary to colon cancer leading to abscess formation. This occurrence is rare, and through literature review only 12 previous cases have been reported with associated bacteremia. Our patient is a 62-year-old female who presented with left upper quadrant pain with a history of tobacco and alcohol abuse that was febrile and hypoxic. Blood cultures were obtained that eventually grew Fusobacterium mortiferum. Computed tomography of the abdomen and the pelvis revealed 2 splenic abscesses that were cultured to grow Escherichia coli and β-hemolytic Streptococcus group C. Colonoscopy was performed, which identified 2 masses that were biopsied, and histopathology confirmed well-differentiated adenocarcinoma with possible muscular invasion. The patient had no other identifiable risk factors for bacterial seeding from another primary source. We present the first reported case report of splenic abscess secondary to colonic adenocarcinoma suspected microperforation associated with Fusobacterium mortiferum bacteremia.
Background: Aripiprazole, a third-generation antipsychotic medication, has been used to treat a range of psychiatric disorders. According to the U.S. Food and Drug Administration's prescribing information, the most common adverse reactions in adult patients in clinical trials (≥10%) were nausea, vomiting, constipation, headache, dizziness, akathisia, anxiety, and insomnia. While hematological adverse effects may occur with aripiprazole, there is very limited information in the published literature on such adverse outcomes. Case presentation: A 68-year-old Caucasian male with treatment resistant depression was hospitalized for suicidal ideation. The patient developed neutropenia after aripiprazole was introduced as an augmentation agent. The neutropenia was reversible with discontinuation of the medication. Conclusions: To our knowledge, we describe the first case report of suspected neutropenia-induced by aripiprazole use in a geriatric patient. While hematological adverse reactions are rare, we recommend adding CBC to the standard adverse systemic reaction monitoring of antipsychotic medications, particularly among the elderly.
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